Within the last two years, a local 40-something Latino gay man with a middle class job and health insurance was on both PEP (Post Exposure Prophylaxis) and PrEP (Pre-Exposure Prophylaxis). In these new HIV Prevention treatments, HIV negative people take the same drugs used to treat HIV positive people. As PEP and PrEP represent new tools for HIV prevention, the community needs to become familiar with them, both as personal options and as policy issues.
In early 2012, Eddy (not his real name) went on PrEP, following discussions with his doctor about Eddy’s risk level for HIV. He had had a few slips and a great deal of anxiety about becoming infected. Eddy was grateful to be able to talk to his doctor about his risk behavior on both an intellectual and an emotional level. Most HIV prevention treats HIV risk as if it’s either a simple behavioral (use condoms) or intellectual issues (you’re at risk for HIV if you have sex without a condom), but Eddy stressed the emotional aspects of his issues in HIV prevention.
While Eddy’s insurance company paid for PrEP, he did find two other barriers, one minor and one major. The only side effect Eddy reported was an upset stomach. PrEP requires people to take Truvada daily for an indefinite period, which drastically increases their opportunities to miss a dose. After a couple of months, Eddy found that he began to miss doses and went off PrEP.
Reflecting on his experience with PrEP, Eddy said “I felt it was like a vaccine, that this was a way to avoid having to use condoms. I would not recommend PrEP to others. It’s not 100 percent fool proof. Your risk factors are still there”.
In 2013 after a possible exposure, Eddy went on PEP, again on his doctor’s recommendation. The PEP regimen consists of two drugs Truvada and Kaletra. Again Eddy reported no problems with his insurance company paying for his treatment.
In the PEP regimen, Eddy had to take one Truvada and four Kaletra pills each day for 28 days. Eddy had no problems maintaining this regimen, but he did report more side effects: fatigue, upset stomach, and insomnia during this period.
Eddy described his emotional state under PEP. “I was a total mess, terrified that I had become infected but I would have been petrified regardless of the treatment. This was a result of the exposure. After the treatment was over, I felt regret for being such a whore, possibly exposing myself, knowing that I could have become infected.”
Contrary to the biomedical or behavioral emphasis of most HIV prevention efforts, in Eddy’s case, emotional issues were never far from the surface, which is not surprising given the effects of HIV on the Gay/Bi Male community.
According to the CDC fact sheet on HIV and Gay/Bisexual Men, Gay/Bi and other MSM experience a greater HIV burden than any other group. While representing only about 2 percent of the U.S. population, Gay/Bi and other MSM accounted for 63 percent of new HIV infections and 56 percent of all people living with HIV/AIDS in the US in 2010. Given the amount of HIV infection among Gay/Bi and other MSM, there is much less room for “slips ups” within this community than others. These new biomedical prevention tools offer more prevention tools. Like them or not, we had all better become familiar with them.
For more information on PrEP visit http://caps.ucsf.edu/wordpress/wp-content/uploads/2012/10/PrEPFS-final.pdf and http://www.cdc.gov/nchhstp/newsroom/docs/2012/PrEP-FactSheet-080912-508.pdf
For the CDC fact sheet on HIV among Gay and Bisexual Men visit http://www.cdc.gov/hiv/risk/gender/msm/facts/
For information on PEP visit http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm